摘要
目的探讨不同吸气峰压(PIP)机械通气(MV)伴450mL/L氧吸入致新生兔肺损伤的病理改变。方法将60只日龄1～5d的新生兔随机分为高PIP组、中PIP组、低PIP组进行MV与未通气对照组,通气后1、3、6h3个时间点取其左肺,病理切片及电镜观察其肺组织结构的改变,行肺泡灌洗液(BALF)蛋白水平测定、细胞计数、沉渣涂片细胞分类,并结合其肺湿干比分析。结果1.光镜下中PIP组肺损伤较低PIP组及高PIP组轻,低PIP组肺叶内局部肺不张较明显,高PIP组肺出血、肺大泡形成较明显。2.随着通气的进行,BALF中细胞计数增高,低PIP组1、3、6h细胞计数分别为:(12.12±7.01)×1012L-1、(12.62±2.98)×1012L-1、(18.55±5.63)×1012L-1,中PIP组为(10.71±2.34)×1012L-1、(14.73±3.63)×1012L-1、(15.48±1.23)×1012L-1,高PIP组为(26.59±7.896)×1012L-1、(22.36±6.799)×1012L-1、(37.34±11.23)×1012L-1;分类中以巨噬细胞和淋巴细胞为主,分叶核升高不明显。BALF中细胞分类计数表明不同的通气模式或同一通气模式不同的时间点细胞反应不同。3.高PIP通气时,Ⅱ型上皮细胞(AT-Ⅱ)增生向AT-Ⅰ细胞转化加速。低压力通气时以AT-Ⅱ细胞肿胀、肺组织水肿为主,低PIP组通气6h就会出现胶原纤维增生。结论新生兔吸入450mL/L的氧时MV会引起肺泡、基底膜结构改变、胶原纤维增生;AT-Ⅱ细胞、淋巴细胞、巨噬细胞变化可能是新生兔机械通气肺损伤的病理基础。MV时肺膨胀有不均一性,低压力通气易致不张伤,高压力通气易致气压伤,适当的压力能减轻肺损伤。
Objective To explore the pathologic change of lung injury caused by mechanical ventilation（MV） at different peak inspiratory pressure（PIP） and 450 mL/L concentration oxygen inhalation in the newborn rabbits.Methods Sixty newborn rabbits aged 1-5 days were arranged randomly to high PIP group,moderate PIP group,low PIP group and no MV control group.All rabbits of ventilation groups were done by MV and killed to obtain lung tissue at 1,3 and 6 h after trail,and the change of lung tissue structure was observed by pathological section and the change of lung ultrastructure was observed by electron microscope,respectively.The broncho-alveolar lavage fluid（BALF） was collected for detecting the concentration of total protein and total cell count and the percentage of cell were classified in BALF sediment film.At the same time the ratio of wet to dry was detected and analyzed.Results 1.The lung injury in moderate PIP group was not severe compared with low PIP group and high PIP group.It was obviously in part pulmonary atelectasis in low PIP group and pulmonary hemorrhage and pulmonary bullae formation in high PIP.2.With the ventilation went on,the cell count in BALF increased at different peak inspiratory pressures and different hours of 1,3,6 h.The values of WBC count in low PIP group at 1,3,6 h,were（12.12±7.01）×10^12 L^-1,（12.62±2.98）×10^12 L^-1,（18.55±5.63）×10^12 L^-1;moderate PIP group were（10.71±2.34）×10^12 L^-1,（14.73±3.63）×10^12 L^-1,（15.48±1.23）×10^12 L^-1;high PIP group were（26.59±7.896）×10^12 L^-1,（22.36±6.799）×10^12 L^-1,（37.34±11.23）×10^12 L^-1 respectively,and the major WBC were macrophage and lymphocyte and slight segmented cell in the cell classification.The change of WBC classification count in BALF indicated that the cell response was different in the different ventilation way and different at different time in the same ventilation way.3.Mechanical ventilation with high PIP accelerated the alveolar typeⅡ（AT-Ⅱ） hyperplasia and convers
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第16期1276-1279,共4页
Journal of Applied Clinical Pediatrics
关键词
机械通气
肺损伤
白细胞
病理
新生兔
mechanical ventilation
lung injury
pathology
newborn rabbits
